Moreno-Palacios Jorge, Maldonado-Alcaraz Efraín, Montoya-Martínez Guillermo, Rivas-Ruiz Rodolfo, Cedillo-López Urbano, Okhunov Zhamshid, Serrano-Brambila Eduardo Alonso
1 Department of Urology, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social , México D.F., México .
J Endourol. 2014 Sep;28(9):1078-84. doi: 10.1089/end.2013.0781. Epub 2014 Jul 1.
To determine the preoperative and perioperative predictive factors of morbidity/mortality in patients undergoing percutaneous nephrolithotomy (PCNL), using the Clavien's classification.
We performed a retrospective chart review of patients who underwent PCNL between January 2005 and January 2012. Preoperative and postoperative factors, such as age, obesity, surgical risk, Charlson comorbidity index, stone complexity, access calix, type of dilator used, and surgery time, were evaluated as predictors of complications.
A total of 354 patients were included in the study. Of these, 56% were women, with the average age of 47±12.5 years. Stone-free rate for noncomplex calculi was 85% and for complex calculi it was 68%. A total of 103 complications were recorded (29.3%). According to the modified Clavien classification system, 32 (9%) were grade 1, 39 (11%) were grade 2, 16 (4.5%) were grade 3A, 8 (2.3%) were grade 3B, 3 (0.8%) were grade 4A, 1 (0.3%) was grade 4B, and 4 (1.1%) were grade 5. In multivariate analysis female gender (odds ratio [OR] 3.1, confidence interval [CI] 1.1-8.0), Charlson score of ≥3 (OR 23.2, CI 3.5-151.1), complex stone (OR 4, CI 1.6-9.6), and duration of surgery of ≥120 minutes (OR 2.9, CI 1.2-6.9) were associated with major complications.
PCNL is a safe procedure with acceptable efficacy for the resolution of renal calculi. The safety of the procedure should improve, especially to reduce the presence of severe complications (Clavien ≥3). We identified factors that are associated with severe complications: female gender, high Charlson, complex calculi, and surgical length ≥120 minutes.
采用Clavien分类法确定经皮肾镜取石术（PCNL）患者术前及围手术期发病率/死亡率的预测因素。
我们对2005年1月至2012年1月期间接受PCNL的患者进行了回顾性病历审查。评估术前和术后因素，如年龄、肥胖、手术风险、Charlson合并症指数、结石复杂性、穿刺肾盏、所用扩张器类型和手术时间，作为并发症的预测因素。
本研究共纳入354例患者。其中，56%为女性，平均年龄47±12.5岁。非复杂性结石的结石清除率为85%，复杂性结石为68%。共记录103例并发症（29.3%）。根据改良的Clavien分类系统，1级32例（9%），2级39例（11%），3A级16例（4.5%），3B级8例（2.3%），4A级3例（0.8%），4B级1例（0.3%），5级4例（1.1%）。多因素分析显示，女性（比值比[OR]3.1，置信区间[CI]1.1 - 8.0）、Charlson评分≥3（OR 23.2，CI 3.5 - 151.1）、复杂性结石（OR 4，CI 1.6 - 9.6）和手术时间≥120分钟（OR 2.9，CI 1.2 - 6.9）与严重并发症相关。
PCNL是一种安全的手术，对解决肾结石具有可接受的疗效。该手术的安全性应得到改善，尤其是减少严重并发症（Clavien≥3级）的发生。我们确定了与严重并发症相关的因素：女性、高Charlson评分、复杂性结石和手术时长≥120分钟。
